Q&A: An increasing number of families are facing food insecurity

The prevalence and dynamics of food insecurity in the United States are changing over time, a troubling finding given that food insecurity is linked to worse health outcomes, according to an expert.

Noura Insolera PhD, MA, a research area specialist for the Panel Study of Income Dynamics (PSID) at the University of Michigan’s Institute for Social Research, wrote in a research letter in JAMA Pediatrics that U.S. children faced food insecurity in 7.6% of all households in 2020.

Previous research has shown that food insecurity in children has been connected to adverse outcomes like lower academic performance, higher rates of diabetes and obesity, poorer diet quality, and mental health issues like anxiety and depression, Insolera wrote.

Top medical organizations have called on policymakers and health officials to address food insecurity, and the White House recently held a meeting to address the growing issue.

Insolera conducted the survey study to compare current trends in chronic food insecurity with those from 20 years ago. She found that low-income families with children faced higher levels of chronic food insecurity than other families from 1999 to 2003: 8.8% vs. 2.1% of all families. The rates were even higher from 2015 to 2019, with 10.9% of low-income families with children facing food insecurity vs. 4.5% of all families.

Insolera spoke with Healio about the prevalence of and health consequences associated with chronic food insecurity, what primary care physicians can learn from the study and more.

Healio: Can you describe your findings and their importance?

Insolera: For the first time in 20 years, data are available to examine chronic food insecurity for a representative sample of families in the United States. I find that both the magnitude and dynamics of chronic food insecurity are changing over time. Although many families are fully food secure at all time points, an increasing number are never fully secure, especially low-income families and low-income families with children. Food insecurity used to be thought of as something that was experienced by a small group of people for relatively short periods of time, but not only is it experienced by more people as time goes on, they are experiencing it in a more persistent way. This new way of looking at food insecurity will allow for a deeper understanding of how individuals and families survive under these subsistent conditions.

Healio: What are the waves of food insecurity described in the letter?

Insolera: This is an excellent point of clarification. The PSID collected information every year from 1968 to 1997 and has collected information every other year since then. Each year that we collect information is referred to as a wave of collection. In this study, I look at two time periods each consisting of three waves of collection: time period 1 aggregates information from 1999, 2001 and 2003, and time period 2 aggregates information from 2015, 2017 and 2019. So, six waves of data collection are compared over 20 years of calendar time.

Healio: What are some of the health consequences associated with food insecurity?

Insolera: Specifically for children, food insecurity is associated with anxiety, depression, poorer diet quality, higher rates of diabetes, higher rates of obesity, lower academic performance and future food insecurity.

Healio: What are the clinical implications of your findings?

Insolera: The clinical implications for these findings are broad in scope. Food insecurity should be a consideration for all types of clinicians, as its consequences span from cognitive and behavioral issues to physical and developmental problems and psychological well-being. Having screener questions on intake forms, follow up contacts for food assistance, and repeated measures are some ways to help families that may need it.

Healio: What is the take-home message for PCPs?

Insolera: The take-home message for PCPs is that food insecurity is not a static issue that is only experienced by one group of people. It is a dynamic process that individuals and families may experience acutely or chronically over the life course. Asking questions about food security and connecting patients with resources that can help to ameliorate the adverse outcomes is key.

Healio: Is there anything else you’d like to add?

Insolera: The most important point to add is that this is the beginning of this branch of research. Due to the lack of data on food insecurity for the same people over time for a nationally representative group of families in the United States, we simply have not been able to look at chronic food security and its various causes and implications.

References:

• American Society for Nutrition publishes comprehensive summary of historic White House Conference on Hunger, Nutrition, and Health. https://www.eurekalert.org/news-releases/979633. Published Feb. 16, 2023. Accessed Feb. 22, 2023.
• Insolera N. JAMA Peds. 2023;doi:10.1001/jamapediatrics.2022.5820.